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Dou L, Shi Z, Cuomu Z, Zhuoga C, Li C, Dawa Z, Li S. Health-related quality of life and its changes of the Tibetan population in China: based on the 2013 and 2018 National Health Services Surveys. BMJ Open 2023; 13:e072854. [PMID: 37984958 PMCID: PMC10660197 DOI: 10.1136/bmjopen-2023-072854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE Health-related quality of life (HRQoL) was an important health outcome measure for evaluating an individual's overall health status. However, there was limited in the literature on HRQoL and its long-term changes of the Tibetan population. This study aimed to assess HRQoL of Tibetan and its changes over time, and explore the differences in HRQoL for residents at different altitudes. DESIGN Data for the cross-sectional study were extracted from the fifth and sixth waves of the National Health Services Surveys which were conducted in 2013 and 2018. A multistage stratified cluster random sampling strategy was used to select representative participants. SETTING Tibet Autonomous Region in China. PARTICIPANTS This study recruited 14 752 participants in 2013 and 13 106 participants in 2018, and after excluding observations with missing values for key variables, 10 247 in 2013 and 6436 in 2018 were included in the study analysis. PRIMARY AND SECONDARY OUTCOME MEASURES The EQ-5D-3L was used to measure participants' HRQoL. RESULTS The mean health state utility scores of the participants were 0.969±0.078 and 0.966±0.077 in 2013 and 2018, respectively. Pain/discomfort was the most frequently prevalent issue reported in 18.1% and 17.9% of the participants in 2013 and 2018, respectively. Tibetans living 3500-4000 m altitude had the best HRQoL. Age, sex, employment status, educational attainment, chronic disease and weekly physical exercise were influencing factors associated with HRQoL. CONCLUSIONS The HRQoL of the Tibetan population was lower than the general Chinese population, and decreased over time between 5 years. There were differences in HRQoL among Tibetan at different altitudes, with residents living at 3500-4000 m having the best quality of life. More attention should be paid to those Tibetans who are older, female, unemployed and without formal education.
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Affiliation(s)
- Lei Dou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
| | - Zhao Shi
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
| | - Zhaxi Cuomu
- Medical College of Tibet University, Lhasa, China
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, China
| | - Cidan Zhuoga
- Medical College of Tibet University, Lhasa, China
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, China
| | - Chaofan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
| | - Zhaxi Dawa
- Medical College of Tibet University, Lhasa, China
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
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Zhuoga C, Cuomu Z, Li S, Dou L, Li C, Dawa Z. Income-related equity in inpatient care utilization and unmet needs between 2013 and 2018 in Tibet, China. Int J Equity Health 2023; 22:85. [PMID: 37165400 PMCID: PMC10173530 DOI: 10.1186/s12939-023-01889-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/08/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Providing equitable access to health care for all populations is an important sustainable development goal. China has made significant progress in achieving equity in healthcare utilization. However, research on equity in healthcare utilization in Tibet is sparse. This study aims to evaluate changes in income-related inequity in inpatient care utilization and unmet needs between 2013 and 2018 among the Tibetan population and identify the inequity source. METHODS Data for this cross-sectional study were obtained from the fifth and sixth waves of the National Health Services Survey in 2013 and 2018. After excluding observations with missing values for key variables, 11,092 and 10,397 respondents were included in this study, respectively. The outcome variables of interest were inpatient service utilization and unmet hospitalization needs. The concentration index and horizontal inequity index (HI) were used to assess income-related inequity. Non-linear decompositions were performed to identify the main contributors to inequity. In the decomposition method, need variables included sex, age, chronic diseases, and the EuroQol-Visual Analog Scale; non-need variables consisted of income, education, employment status, marital status, and health insurance schemes. RESULTS The probability of inpatient care utilization increased from 6.40% in 2013 to 8.50% in 2018. The HI for inpatient care utilization was 0.19 (P < 0.001) in 2013, whereas it decreased to 0.07 (P < 0.001) in 2018. The contribution of income to inequity in inpatient care utilization decreased from 87.09% in 2013 to 59.79% in 2018. As for unmet inpatient care needs, although its probability increased from 0.76 to 1.48%, the percentage of reasons for financial hardship decreased from 47.62 to 28.57%. The HI for unmet hospitalization need was - 0.07 in 2013 and - 0.05 in 2018, and neither was statistically significant. The New Rural Cooperative Medical Scheme made majority contributions to promote equity in unmet hospitalization need. Moreover, the female respondents reporting low EuroQol-Visual Analog Scale scores and patients with chronic disease were not only more likely to seek for inpatient care, but also have more unmet need than the reference groups. CONCLUSIONS The inequity in inpatient care utilization in Tibet narrowed from 2013 to 2018, and there was no inequity in unmet hospitalization needs in 2013 and 2018. Income and the New Rural Cooperative Medical Scheme are the main drivers of equity promotion. To promote access to inpatient care utilization and decrease the probability of unmet hospitalization need in future, policymakers should target high-need residents in Tibet to improve accessibility, availability, and acceptability.
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Affiliation(s)
- Cidan Zhuoga
- Medical College of Tibet University, Lhasa, 850000, China
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, 850000, China
| | - Zhaxi Cuomu
- Medical College of Tibet University, Lhasa, 850000, China
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, 850000, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Lei Dou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Chaofan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
- Center for Health Preference Research, Shandong University, Jinan, 250012, China.
| | - Zhaxi Dawa
- Medical College of Tibet University, Lhasa, 850000, China.
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, 850000, China.
- High Altitude Health Science Research Center, Tibet University, Lhasa, 850000, China.
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Lu Y, Jin H, Zhao Y, Li Y, Xu J, Tian J, Luan X, Chen S, Sun W, Zhang S, Xu S, Zhu F, Chen L, Mima D, Sun Y, Zhuoga C. Impact of Increased Hemoglobin on Spontaneous Intracerebral Hemorrhage. Neurocrit Care 2021; 36:395-403. [PMID: 34313936 PMCID: PMC8964592 DOI: 10.1007/s12028-021-01305-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Abstract
Background Studies of the impact of increased hemoglobin on spontaneous intracerebral hemorrhage (ICH) are limited. The present study aimed to explore the effect of increased hemoglobin on ICH. Methods A retrospective single-center study using medical records from a database processed by univariate and multivariate analyses was performed in the People’s Hospital of Tibet Autonomous Region in Lhasa, Tibet, China. Results The mean hemoglobin level in 211 patients with ICH was 165.03 ± 34.12 g/l, and a median hematoma volume was 18.5 ml. Eighty-eight (41.7%) patients had large hematomas (supratentorial hematoma ≥ 30 ml; infratentorial hematoma ≥ 10 ml). No differences in ICH risk factors between the groups with different hemoglobin levels were detected. Increased hemoglobin was independently associated with large hematomas [odds ratio (OR) 1.013, P = 0.023]. Increased hemoglobin was independently associated with ICH with subarachnoid hemorrhage (OR 1.014, P = 0.016), which was more pronounced in men (OR 1.027, P = 0.002). Increased hemoglobin was independently associated with basal ganglia hemorrhage and lobar hemorrhage in men (OR 0.986, P = 0.022; OR 1.013, P = 0.044, respectively) but not in women (P > 0.1). Conclusions Increased hemoglobin was independently associated with large hemorrhage volume. Increased hemoglobin was independently associated with lobar hemorrhage in men and ICH with subarachnoid hemorrhage, which was more pronounced in men. Additional studies are needed to confirm our findings and explore potential mechanisms.
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Affiliation(s)
- Yuxuan Lu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yuhua Zhao
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China
| | - Yuxian Li
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Jun Xu
- Department of Cognitive Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiayu Tian
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Xiaoting Luan
- Department of Neurology, The First Hospital of Tsinghua University, Beijing, China
| | - Siwei Chen
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Shouzi Zhang
- Department of Psychiatry, Beijing Geriatric Hospital, Beijing, China
| | - Shunliang Xu
- Department of Neurology, the Second Hospital, Shandong University, Jinan, Shandong Province, China
| | - Feiqi Zhu
- Cognitive Impairment Ward of Neurology Department, the Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, China
| | - Luzeng Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Dunzhu Mima
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China
| | - Yongan Sun
- Department of Neurology, Peking University First Hospital, Beijing, China.
| | - Cidan Zhuoga
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China.
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Lu Y, Zhuoga C, Jin H, Zhu F, Zhao Y, Ding Z, He S, Du A, Xu J, Luo J, Sun Y. Characteristics of acute ischemic stroke in hospitalized patients in Tibet: a retrospective comparative study. BMC Neurol 2020; 20:380. [PMID: 33087079 PMCID: PMC7576739 DOI: 10.1186/s12883-020-01957-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Numerous studies on acute ischemic stroke (AIS) have been conducted at low-altitude regions, and the related findings have been used to guide clinical management. However, corresponding studies at high altitude are few. This study aimed to analyse the clinical characteristics of AIS patients at high-altitude regions through a hospital-based comparative study between Tibet and Beijing. METHODS This study included the diagnoses of AIS patients from People's Hospital of Tibet Autonomous Region (PHOTAR) and Peking University First Hospital (PUFH) between 1 January 2014 and 31 December 2017, where data including patient demographics, treatment time, onset season, risk factors, infarction location, laboratory data, image examination results, treatments, and AIS subtype were collected and compared. Continuous and categorical variables were analysed with a two-sample t-test or Wilcoxon rank sum test and chi-square test, respectively. Significant risk factors were examined with binary logistic regression analysis. RESULTS In total, 236 and 1021 inpatients from PHOTAR and PUFH were included, respectively. The PHOTAR patients were younger than the PUFH patients (P < 0.001). Young adult stroke, erythrocytosis, and hyperhomocysteinemia were more frequent in PHOTAR patients (all P < 0.001). Other vascular risk factors, including hypertension, diabetes mellitus, hyperlipidaemia, smoking and alcohol consumption history, were less prevalent in PHOTAR patients than in PUFH patients. The rate of intravenous thrombolysis and the rate of within intravenous thrombolysis window time were also lower in PHOTAR patients (both P < 0.001). The PHOTAR group also tended to have anterior circulation infarction. Erythrocytosis and hyperhomocysteinemia were independent risk factors in PHOTAR, and young adults accounted for a larger proportion of stroke cases. CONCLUSION In Tibet, AIS patients were relatively younger, and anterior circulation infarctions were more common. Erythrocytosis and hyperhomocysteinemia may contribute to these differences. Here, young adult stroke also accounted for a higher proportion, and this may be associated with erythrocytosis. Our findings present the first hospital-based comparative study in Tibet and may contribute to policies for stroke prevention in this region.
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Affiliation(s)
- Yuxuan Lu
- Department of Neurology, Peking University First Hospital, No. 8, Xishiku St, Xicheng District, Beijing, 100034, China
| | - Cidan Zhuoga
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, 850000, Tibet, China
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital, No. 8, Xishiku St, Xicheng District, Beijing, 100034, China
| | - Feiqi Zhu
- Cognitive Impairment Ward of Neurology Department, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, 518005, China
| | - Yuhua Zhao
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, 850000, Tibet, China
| | - Zhijie Ding
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, 850000, Tibet, China
| | - Shihua He
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, 850000, Tibet, China
| | - Ailian Du
- Department of Neurology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200050, China
| | - Jun Xu
- Department of Cognitive Neurology, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Jingjing Luo
- Department of Neurology, Peking University First Hospital, No. 8, Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Yongan Sun
- Department of Neurology, Peking University First Hospital, No. 8, Xishiku St, Xicheng District, Beijing, 100034, China.
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Jin H, Ding Z, Lian S, Zhao Y, He S, Zhou L, Zhuoga C, Wang H, Xu J, Du A, Yan G, Sun Y. Prevalence and Risk Factors of White Matter Lesions in Tibetan Patients Without Acute Stroke. Stroke 2020; 51:149-153. [PMID: 31679502 DOI: 10.1161/strokeaha.119.027115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Studies on the prevalence and risk factors of white matter lesions (WMLs) in Tibetans living at high altitudes are scarce. We conducted this study to determine the prevalence and risks of WMLs in Tibetan patients without or with nonacute stroke.
Methods—
We undertook a retrospective analysis of medical records of patients treated at the People’s Hospital of Tibetan Autonomous Region and identified a total of 301 Tibetan patients without acute stroke. WML severity was graded by the Fazekas Scale. We assessed the overall and age-specific prevalence of WMLs and analyzed associations between WMLs and related factors with univariate and multivariate methods.
Results—
Of the 301 patients, 87 (28.9%) had peripheral vertigo, 83 (27.3%) had primary headache, 52 (17.3%) had a history of stroke, 36 (12.0%) had an anxiety disorder, 29 (9.6%) had epilepsy, 12 (4.0%) had infections of the central nervous system, and 3 (1.0%) had undetermined diseases. WMLs were present in 245 (81.4%) patients, and 54 (17.9%) were younger than 40 years. Univariate analysis showed that age, history of cerebral infarction, hypertension, the thickness of the common carotid artery intima, and plaque within the intracarotid artery were related risks for WMLs. Ordered logistic analysis showed that age, history of cerebral ischemic stroke, hypertension, male sex, and atrial fibrillation were associated with WML severity.
Conclusions—
Risk factors for WMLs appear similar for Tibetans residing at high altitudes and individuals living in the plains. Further investigations are needed to determine whether Tibetans residing at high altitudes have a higher burden of WMLs than inhabitants of the plains.
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Affiliation(s)
- Haiqiang Jin
- From the Department of Neurology, Peking University First Hospital, Beijing, China (H.J., S.L., Y.S.)
| | - Zhijie Ding
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China (Z.D., Y.Z., S.H., C.Z.)
| | - Siqing Lian
- From the Department of Neurology, Peking University First Hospital, Beijing, China (H.J., S.L., Y.S.)
| | - Yuhua Zhao
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China (Z.D., Y.Z., S.H., C.Z.)
| | - Shihua He
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China (Z.D., Y.Z., S.H., C.Z.)
| | - Lewei Zhou
- Academy of Mathematics and Systems Science, Chinese Academy of Sciences, Beijing, China (L.Z., G.Y.)
| | - Cidan Zhuoga
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China (Z.D., Y.Z., S.H., C.Z.)
| | - Huali Wang
- Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, Beijing, China (H.W.)
| | - Jun Xu
- Department of Cognitive Neurology, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing Tian Tan Hospital, Affiliated to Capital Medical University, China (J.X.)
| | - Ailian Du
- Department of Neurology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, China (A.D.)
| | - Guiying Yan
- Academy of Mathematics and Systems Science, Chinese Academy of Sciences, Beijing, China (L.Z., G.Y.)
| | - Yongan Sun
- From the Department of Neurology, Peking University First Hospital, Beijing, China (H.J., S.L., Y.S.)
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Zhao Y, Yao Z, D'Souza W, Zhu C, Chun H, Zhuoga C, Zhang Q, Hu X, Zhou D. An Epidemiological Survey of Stroke in Lhasa, Tibet, China. Stroke 2010; 41:2739-43. [PMID: 20966420 DOI: 10.1161/strokeaha.110.586669] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background and Purpose—
There have not been any new epidemiological studies related to stroke in Tibet for 20 years. This study aimed to collect stroke data from The City Staff Medical Insurance Registry in Lhasa, Tibet, to describe the incidence, clinical subtypes, and associated risk factors of stroke.
Methods—
We used retrospective, population-based descriptive analysis of all urban and rural workers in the City Staff Medical Insurance Registry who were admitted to designated hospitals from October 2006 to October 2008. Stroke was defined by the International Classification of Disease (ICD)-10 coded from hospital records.
Results—
Workers (81 298) were listed in the City Staff Medical Insurance Registry. Stroke patients (165) were included in the study, with 133 being first-ever patients. The age-standardized incidence rate was 88.725/100 000 per year (95% CI, 72.228–105.221), and mortality rate was 25.941/100 000 per year (95% CI, 16.416–35.466). The case fatality rate was 21.82%. Seventeen of the 133 patients (12.8%) were <45 years of age. Stroke incidence rate was higher in ethnic Han patients than ethnic Tibetan patients. The most common subtype was cerebral infarction, and the most important risk factor was hypertension.
Conclusion—
Since the last study 20 years ago in Lhasa, stroke remains the primary fatal disease for the elderly, and its occurrence at younger ages is higher in Lhasa than in other areas of China. However, the annual incidence rate and mortality rate have decreased. The annual incidence rate is at a similar level to that in other parts of China. The primary subtype of stroke in Lhasa is cerebral ischemia.
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Affiliation(s)
- Yuhua Zhao
- From the Department of Neurology (Y.Z., Z.Y., C.Z., Q.Z., D.Z.), West China Hospital, Chengdu, Sichuan, China; Department of Medicine (W.D.), St Vincent’s Hospital and Centre for MEGA Epidemiology, Fitzroy, Victoria, Australia; Department of Health Statistics (C.Z.), West China School of Public Health, Sichuan University, Chengdu, Sichuan, China; University of Tibet (H.C.), Lhasa, Tibet, China; People’s Hospital of Tibet Autonomous Region (Y.Z., X.H.), Lhasa, Tibet, China
| | - Zhiping Yao
- From the Department of Neurology (Y.Z., Z.Y., C.Z., Q.Z., D.Z.), West China Hospital, Chengdu, Sichuan, China; Department of Medicine (W.D.), St Vincent’s Hospital and Centre for MEGA Epidemiology, Fitzroy, Victoria, Australia; Department of Health Statistics (C.Z.), West China School of Public Health, Sichuan University, Chengdu, Sichuan, China; University of Tibet (H.C.), Lhasa, Tibet, China; People’s Hospital of Tibet Autonomous Region (Y.Z., X.H.), Lhasa, Tibet, China
| | - Wendyl D'Souza
- From the Department of Neurology (Y.Z., Z.Y., C.Z., Q.Z., D.Z.), West China Hospital, Chengdu, Sichuan, China; Department of Medicine (W.D.), St Vincent’s Hospital and Centre for MEGA Epidemiology, Fitzroy, Victoria, Australia; Department of Health Statistics (C.Z.), West China School of Public Health, Sichuan University, Chengdu, Sichuan, China; University of Tibet (H.C.), Lhasa, Tibet, China; People’s Hospital of Tibet Autonomous Region (Y.Z., X.H.), Lhasa, Tibet, China
| | - Cairong Zhu
- From the Department of Neurology (Y.Z., Z.Y., C.Z., Q.Z., D.Z.), West China Hospital, Chengdu, Sichuan, China; Department of Medicine (W.D.), St Vincent’s Hospital and Centre for MEGA Epidemiology, Fitzroy, Victoria, Australia; Department of Health Statistics (C.Z.), West China School of Public Health, Sichuan University, Chengdu, Sichuan, China; University of Tibet (H.C.), Lhasa, Tibet, China; People’s Hospital of Tibet Autonomous Region (Y.Z., X.H.), Lhasa, Tibet, China
| | - Hua Chun
- From the Department of Neurology (Y.Z., Z.Y., C.Z., Q.Z., D.Z.), West China Hospital, Chengdu, Sichuan, China; Department of Medicine (W.D.), St Vincent’s Hospital and Centre for MEGA Epidemiology, Fitzroy, Victoria, Australia; Department of Health Statistics (C.Z.), West China School of Public Health, Sichuan University, Chengdu, Sichuan, China; University of Tibet (H.C.), Lhasa, Tibet, China; People’s Hospital of Tibet Autonomous Region (Y.Z., X.H.), Lhasa, Tibet, China
| | - Cidan Zhuoga
- From the Department of Neurology (Y.Z., Z.Y., C.Z., Q.Z., D.Z.), West China Hospital, Chengdu, Sichuan, China; Department of Medicine (W.D.), St Vincent’s Hospital and Centre for MEGA Epidemiology, Fitzroy, Victoria, Australia; Department of Health Statistics (C.Z.), West China School of Public Health, Sichuan University, Chengdu, Sichuan, China; University of Tibet (H.C.), Lhasa, Tibet, China; People’s Hospital of Tibet Autonomous Region (Y.Z., X.H.), Lhasa, Tibet, China
| | - Qin Zhang
- From the Department of Neurology (Y.Z., Z.Y., C.Z., Q.Z., D.Z.), West China Hospital, Chengdu, Sichuan, China; Department of Medicine (W.D.), St Vincent’s Hospital and Centre for MEGA Epidemiology, Fitzroy, Victoria, Australia; Department of Health Statistics (C.Z.), West China School of Public Health, Sichuan University, Chengdu, Sichuan, China; University of Tibet (H.C.), Lhasa, Tibet, China; People’s Hospital of Tibet Autonomous Region (Y.Z., X.H.), Lhasa, Tibet, China
| | - Xuejun Hu
- From the Department of Neurology (Y.Z., Z.Y., C.Z., Q.Z., D.Z.), West China Hospital, Chengdu, Sichuan, China; Department of Medicine (W.D.), St Vincent’s Hospital and Centre for MEGA Epidemiology, Fitzroy, Victoria, Australia; Department of Health Statistics (C.Z.), West China School of Public Health, Sichuan University, Chengdu, Sichuan, China; University of Tibet (H.C.), Lhasa, Tibet, China; People’s Hospital of Tibet Autonomous Region (Y.Z., X.H.), Lhasa, Tibet, China
| | - Dong Zhou
- From the Department of Neurology (Y.Z., Z.Y., C.Z., Q.Z., D.Z.), West China Hospital, Chengdu, Sichuan, China; Department of Medicine (W.D.), St Vincent’s Hospital and Centre for MEGA Epidemiology, Fitzroy, Victoria, Australia; Department of Health Statistics (C.Z.), West China School of Public Health, Sichuan University, Chengdu, Sichuan, China; University of Tibet (H.C.), Lhasa, Tibet, China; People’s Hospital of Tibet Autonomous Region (Y.Z., X.H.), Lhasa, Tibet, China
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